As health reform debates proceed and the year ends, you may wonder: Who is naughty and nice?
Who is nice?
The nice guys are Goodists.
Goodists, as defined by Bret Stephens of the Wall Street Journal editorial board, are people who believe,
• All conflicts stem from avoidable misunderstandings. These misunderstandings come from those who refuse to believe a paternalistic government should totally run the health system for the common good..
• The health system’s evils spring from overused technologies, dysfunctional doctors, and medical industrial complexes, who rely on profit to exist.
• Goodists, known for pure hearts where love abides, do not see a place for profits, but in using society’s money.
• Hope and goodness will change the world, as long as all are equal. Universal equity is their destiny.
• High moral intentions are paramount, not the efficacy of their actions.
• Education, as taught by themselves, will solve everything, and the world must be reset around their educational precepts.
• Goodists must yearn and strive and be hailed as Good.
Goodists, above all, know all other Goodists are nice.
Goodists know the naughty are Badists who,
• Question Goodists’ Goodness.
• Criticize Goodists’ intentions.
• Point out adverse consequences of Goodists’ actions.
• Believe human conflicts are inevitable for reasons of belief.
• Think the status quo isn’t all bad.
• Do not seek to be loved for niceness but respected for competence.
So be Good, for Goodist Sake. And remember. Even hard-hearted Badists have some Good in their Souls.
Thursday, December 31, 2009
Wednesday, December 30, 2009
Health Reform Threatens U.S. Lead in Medical Innovation
U.S. Lead in Medical Innovation Under Threat from Reform Bills
By: Kishore Jethanandani
Preface: In the following article, in Health Care News, published by the Heartland Institute, the author quotes my views, as well as those of other authorities on innovation on the negative impact of reform. Her main points are; 1) current reform bills undermine innovation; 2) the U.S. outperforms socialized systems in developing new drugs, devices, and information technologies by a wide margin, largely due to market-based compensation incentives.
______________________________________
A new study measuring medical innovation puts the United States at the top of the list for advancements, identifying an area where the benefits of a free market system are clearly outweighing those of socialized medicine, an advantage the health care legislation currently under consideration could seriously undermine.
Outperforming Socialized Medicine
Many proponents of socialized medicine point out the American health care system spends more money and performs poorly compared to government-run systems in Canada and Europe. A World Health Organization study conducted in 2000—which was abandoned after methodological flaws were identified—indicated the United States lags behind countries with socialized medicine in metrics such as life expectancy and infant mortality.
Yet one measure of progress—medical innovation—was conspicuously absent from most studies until the Cato Institute released a new report, “Bending the Productivity Curve: Why America Leads the World in Medical Innovation,” by Glen Whitman and Raymond Raad and published in November 2009.
U.S. preeminence in research is indicated by the number of Nobel Prizes awarded for medicine, and by roughly $30 billion in annual research spending via the National Institutes of Health versus $4 billion in all of Europe.
“Of the 95 recipients in the past 40 years, 57 (60 percent) were from the United States, while 40 (42 percent) were from the European Union countries, Switzerland, Canada, Japan, or Australia—countries whose combined population is more than double that of the United States,” the authors write. [Editor’s note: Two recipients are identified by the authors as being from both the United States and another country.]
Measuring Actual Effects
The study concentrates on truly effective innovations and avoids standard but potentially deceptive measures such as expenditures on research and development or bald numbers of new products launched, in diagnostics, therapeutics, and pharmaceuticals.
“Innovation is best measured by looking at advances that have withstood the test of time and are widely regarded as having had important positive effects on health care,” the authors write.
The researchers took a list of 30 major innovations in diagnostics and therapeutics and ranked their importance based on feedback from 225 leading primary physicians.
“[Of the] 27 innovations for which a country was identified, work performed in the United States significantly contributed to the invention or advancement of 20, including nine of the top 10.” Regarding drugs, “Sixteen of the 29 representative drug classes were developed in the United States, while 15 were developed in the EU or Switzerland.”
A key factor explaining these vast differences is the role market-based compensation plays in the United States, the authors note.
“Single-payer and other centrally organized health care systems, like those in much of Europe, are characterized by a great deal of monopsony [buyer] power that pushes down compensation. Prices for prescription drugs in Europe are 35 percent to 55 percent lower than in the United States,” they explain.
Infant Mortality Myth Busted
The study criticizes certain metrics, particularly references to infant mortality, a measure that has come under fire from other observers.
“Americans are far more aggressive in trying to save the lives of tiny premature babies. In some of the world’s most advanced nations where governments run the health care system, prematurely born infants are viewed as too expensive. It is just not cost effective to allow them to be born,” notes Gregory Dattilo, coauthor of Your Health Matters (Alethos Press 2006, $24.95).
Socialization Hurts
According to Tevi Troy, a senior fellow at the Hudson Institute, a U.S. move toward a more socialized system could erode the incentives that drive innovation in drugs, devices, and information technology here.
“The unlocking of the human genome and knowledge of the micro-level determinants of human health, health informatics and the thousands of records that help us understand what works, and personalized medicine are in jeopardy with price controls and additional fees,” said Troy.
Dr. Richard Reece, a consultant to several innovation-focused health care companies, agrees the reform plans under consideration in Washington could suppress innovation.
“Many of the new innovations, especially in medical devices, are tied to new business models for reducing costs and improving quality”, said Reece. “These devices are often developed or adopted in creative ways by small primary physician groups to save costs by reducing the need for recourse to specialists. Small physician groups can barely afford to set aside the time and financial resources to organize their practices for new technology and will be adversely affected when costs of equipment rise as a result of taxes charged on medical devices.”
Undermining Innovation
According to Grace-Marie Turner, president of Galen Institute, which recently held a conference on health care innovation in Washington, DC, the proposed health care reforms will centralize decision-making within the government and create a climate of uncertainty.
“Comparative effectiveness research will add another layer of uncertainty and costs for emerging biotech companies on top of compliance with FDA rules,” said Turner. “Medical devices such as implantable defibrillators have already encountered obstacles due to a preference for lower rates of compensation by Medicare, and health care reforms will extend these disincentives for innovation.”
Jason Hwang, executive director of the Innosight Institute, a health care consulting firm in Massachusetts, agrees.
“Innovation is possible when patients have choices and are empowered to make decisions,” said Hwang. “The proposed health care mandates and comparative effectiveness research based government decision-making will undermine innovation.”
Kishore Jethanandani (kishorejets@gmail.com) writes from San Francisco.
Online Resources:“Bending the Productivity Curve: Why America Leads the World in Medical Innovation,” Cato Institute:
http://www.heartland.org/healthpolicy-news.org/article
By: Kishore Jethanandani
Preface: In the following article, in Health Care News, published by the Heartland Institute, the author quotes my views, as well as those of other authorities on innovation on the negative impact of reform. Her main points are; 1) current reform bills undermine innovation; 2) the U.S. outperforms socialized systems in developing new drugs, devices, and information technologies by a wide margin, largely due to market-based compensation incentives.
______________________________________
A new study measuring medical innovation puts the United States at the top of the list for advancements, identifying an area where the benefits of a free market system are clearly outweighing those of socialized medicine, an advantage the health care legislation currently under consideration could seriously undermine.
Outperforming Socialized Medicine
Many proponents of socialized medicine point out the American health care system spends more money and performs poorly compared to government-run systems in Canada and Europe. A World Health Organization study conducted in 2000—which was abandoned after methodological flaws were identified—indicated the United States lags behind countries with socialized medicine in metrics such as life expectancy and infant mortality.
Yet one measure of progress—medical innovation—was conspicuously absent from most studies until the Cato Institute released a new report, “Bending the Productivity Curve: Why America Leads the World in Medical Innovation,” by Glen Whitman and Raymond Raad and published in November 2009.
U.S. preeminence in research is indicated by the number of Nobel Prizes awarded for medicine, and by roughly $30 billion in annual research spending via the National Institutes of Health versus $4 billion in all of Europe.
“Of the 95 recipients in the past 40 years, 57 (60 percent) were from the United States, while 40 (42 percent) were from the European Union countries, Switzerland, Canada, Japan, or Australia—countries whose combined population is more than double that of the United States,” the authors write. [Editor’s note: Two recipients are identified by the authors as being from both the United States and another country.]
Measuring Actual Effects
The study concentrates on truly effective innovations and avoids standard but potentially deceptive measures such as expenditures on research and development or bald numbers of new products launched, in diagnostics, therapeutics, and pharmaceuticals.
“Innovation is best measured by looking at advances that have withstood the test of time and are widely regarded as having had important positive effects on health care,” the authors write.
The researchers took a list of 30 major innovations in diagnostics and therapeutics and ranked their importance based on feedback from 225 leading primary physicians.
“[Of the] 27 innovations for which a country was identified, work performed in the United States significantly contributed to the invention or advancement of 20, including nine of the top 10.” Regarding drugs, “Sixteen of the 29 representative drug classes were developed in the United States, while 15 were developed in the EU or Switzerland.”
A key factor explaining these vast differences is the role market-based compensation plays in the United States, the authors note.
“Single-payer and other centrally organized health care systems, like those in much of Europe, are characterized by a great deal of monopsony [buyer] power that pushes down compensation. Prices for prescription drugs in Europe are 35 percent to 55 percent lower than in the United States,” they explain.
Infant Mortality Myth Busted
The study criticizes certain metrics, particularly references to infant mortality, a measure that has come under fire from other observers.
“Americans are far more aggressive in trying to save the lives of tiny premature babies. In some of the world’s most advanced nations where governments run the health care system, prematurely born infants are viewed as too expensive. It is just not cost effective to allow them to be born,” notes Gregory Dattilo, coauthor of Your Health Matters (Alethos Press 2006, $24.95).
Socialization Hurts
According to Tevi Troy, a senior fellow at the Hudson Institute, a U.S. move toward a more socialized system could erode the incentives that drive innovation in drugs, devices, and information technology here.
“The unlocking of the human genome and knowledge of the micro-level determinants of human health, health informatics and the thousands of records that help us understand what works, and personalized medicine are in jeopardy with price controls and additional fees,” said Troy.
Dr. Richard Reece, a consultant to several innovation-focused health care companies, agrees the reform plans under consideration in Washington could suppress innovation.
“Many of the new innovations, especially in medical devices, are tied to new business models for reducing costs and improving quality”, said Reece. “These devices are often developed or adopted in creative ways by small primary physician groups to save costs by reducing the need for recourse to specialists. Small physician groups can barely afford to set aside the time and financial resources to organize their practices for new technology and will be adversely affected when costs of equipment rise as a result of taxes charged on medical devices.”
Undermining Innovation
According to Grace-Marie Turner, president of Galen Institute, which recently held a conference on health care innovation in Washington, DC, the proposed health care reforms will centralize decision-making within the government and create a climate of uncertainty.
“Comparative effectiveness research will add another layer of uncertainty and costs for emerging biotech companies on top of compliance with FDA rules,” said Turner. “Medical devices such as implantable defibrillators have already encountered obstacles due to a preference for lower rates of compensation by Medicare, and health care reforms will extend these disincentives for innovation.”
Jason Hwang, executive director of the Innosight Institute, a health care consulting firm in Massachusetts, agrees.
“Innovation is possible when patients have choices and are empowered to make decisions,” said Hwang. “The proposed health care mandates and comparative effectiveness research based government decision-making will undermine innovation.”
Kishore Jethanandani (kishorejets@gmail.com) writes from San Francisco.
Online Resources:“Bending the Productivity Curve: Why America Leads the World in Medical Innovation,” Cato Institute:
http://www.heartland.org/healthpolicy-news.org/article
Obama: A C- On Health Reform
President Obama, in a recent Oprah Winfrey interview, gave himself a “solid B+” for his overall performance for his first year in office.
Frankly, it is beyond my pay grade or competence to judge Obama’s overall performance. I will leave that to the American people, who will have their first chance to register their opinion in the November 2010 off-year elections.
I give Obama a weak C- on health reform. This puts me somewhere in the middle of the opinion spectrum.
• Uwe Rinehart, the Princeton health care economist, gives Obama an A- in a Health Affairs blog.
• David Brooks, the New York Times columnist, gives him a B.
• Jeffrey Flier, MD. Dean of the Harvard Medical School, gives Obama a “failing grade” in a November 17 Wall Street Journal Op-Ed piece.
Flier’s article, coming out the rarified pro-Obama atmosphere of Boston, surprised me. Flier reasons, “There are no provisions to substantially control the growth of costs of quality of care...in discussions with dozens of health-care leaders and economists, I find near unanimity of opinion, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending, rather than restrain it...In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system– now with many more participants. This will make an eventual solution even more difficult. Ultimately our capacity to innovate and develop new therapies would suffer most of all.”
Flier cites the Massachusetts example, where coverage was expanded and costs exploded over the last three years of a universal coverage plan. In Massachusetts, a “Special Commission” has decided capitation will be needed to replace fee-for-service to control costs. :Unfortunately," Flier says, "The details of such a massive change are completely unspecified...We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.”
Which brings me to my C- grade.
I like certain things about reform proposals- expanding coverage to 31 million uninsured and covering those with pre-existing illnesses. I dislike others - not allowing consumers to shop for plans across state lines. limiting tax deductions for HSAs, taking no real action on tort reform.
Obama and the Democrats are telling us government knows what is best and they are not the slightest bit interested in what people or doctors think. They are not interested in what dissenting authoritative experts have to say; they are not interested in holding hearings on the final proposals; they are not going to let Republicans contribute to the negotiations; they do not give a damn what others thinks.
They ignore overwhelming and exploding public opposition. They believe a new Medicare Commission ought to have the power to overrule doctors, and government has the right to choose cheaper alternatives to expensive care.
Democrats are simply obsessed with making “history,” even in the face of countervailing opinions and empirical evidence that what they propose might not work.
I find such “top-down” power brokering arrogant and ignorant. It is arrogant in that it thinks it knows best while the public and doctors know least and in that it practices financial sleight-of-hand, such as taxing immediately and delaying benefits for 4 to 6 years.
It is ignorant in ignoring such fundamentals as the growing doctors shortage, which grows worse by the day; in believing that all Medicare payments ought to be equal for all regions of the country, no matter what the poverty levels in those regions; in preaching the gospel that EMRs, preventive care, and coordinating care will somehow save more towards the end of the decade, despite evidence to the contrary; in believing you can cut $500 billion out Medicare without cutting benefits; in finessing and hiding such issues as market and consumer-driven care, which has been shown to control costs and enhance quality through competition; and in failing to acknowledge that American medical technologies are the best in the world and that the health care sector is one of the few economic growth sectors.
Frankly, it is beyond my pay grade or competence to judge Obama’s overall performance. I will leave that to the American people, who will have their first chance to register their opinion in the November 2010 off-year elections.
I give Obama a weak C- on health reform. This puts me somewhere in the middle of the opinion spectrum.
• Uwe Rinehart, the Princeton health care economist, gives Obama an A- in a Health Affairs blog.
• David Brooks, the New York Times columnist, gives him a B.
• Jeffrey Flier, MD. Dean of the Harvard Medical School, gives Obama a “failing grade” in a November 17 Wall Street Journal Op-Ed piece.
Flier’s article, coming out the rarified pro-Obama atmosphere of Boston, surprised me. Flier reasons, “There are no provisions to substantially control the growth of costs of quality of care...in discussions with dozens of health-care leaders and economists, I find near unanimity of opinion, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending, rather than restrain it...In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system– now with many more participants. This will make an eventual solution even more difficult. Ultimately our capacity to innovate and develop new therapies would suffer most of all.”
Flier cites the Massachusetts example, where coverage was expanded and costs exploded over the last three years of a universal coverage plan. In Massachusetts, a “Special Commission” has decided capitation will be needed to replace fee-for-service to control costs. :Unfortunately," Flier says, "The details of such a massive change are completely unspecified...We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.”
Which brings me to my C- grade.
I like certain things about reform proposals- expanding coverage to 31 million uninsured and covering those with pre-existing illnesses. I dislike others - not allowing consumers to shop for plans across state lines. limiting tax deductions for HSAs, taking no real action on tort reform.
Obama and the Democrats are telling us government knows what is best and they are not the slightest bit interested in what people or doctors think. They are not interested in what dissenting authoritative experts have to say; they are not interested in holding hearings on the final proposals; they are not going to let Republicans contribute to the negotiations; they do not give a damn what others thinks.
They ignore overwhelming and exploding public opposition. They believe a new Medicare Commission ought to have the power to overrule doctors, and government has the right to choose cheaper alternatives to expensive care.
Democrats are simply obsessed with making “history,” even in the face of countervailing opinions and empirical evidence that what they propose might not work.
I find such “top-down” power brokering arrogant and ignorant. It is arrogant in that it thinks it knows best while the public and doctors know least and in that it practices financial sleight-of-hand, such as taxing immediately and delaying benefits for 4 to 6 years.
It is ignorant in ignoring such fundamentals as the growing doctors shortage, which grows worse by the day; in believing that all Medicare payments ought to be equal for all regions of the country, no matter what the poverty levels in those regions; in preaching the gospel that EMRs, preventive care, and coordinating care will somehow save more towards the end of the decade, despite evidence to the contrary; in believing you can cut $500 billion out Medicare without cutting benefits; in finessing and hiding such issues as market and consumer-driven care, which has been shown to control costs and enhance quality through competition; and in failing to acknowledge that American medical technologies are the best in the world and that the health care sector is one of the few economic growth sectors.
Monday, December 28, 2009
Contrasting Views on Health Reform Bill
What a strange contrast we find ourselves in —a clear majority of Americans is opposed to what health reform bills offer ; congressional representatives know they are acting against the will of the people, and they have just accepted borrowed money for their districts and states to compensate for their unpopular actions. Meanwhile Democrats are proclaiming their vote is historic, and Republicans agree.
“This vote is indeed historic. This Congress will be remembered for its arrogance, corruption and stupidity. In the year of 2009, a Congress ignored the coming economic storm and impending bankruptcy of our entitlement programs and embarked on an ideological crusade to bring our nation as close to single-payer, government-run health care as possible. If this bill becomes law, future generations will rue this day and I will do everything in my power to work toward its repeal. This bill will ration care, cut Medicare, increase premiums, fund abortion and bury our children in debt.”
“This process was not compromise. This process was corruption. This bill passed because votes were bought and sold using the issue of abortion as a bargaining chip. The abortion provision alone makes this bill the most arrogant piece of legislation I have seen in Congress. Only the most condescending politician can believe it is appropriate to force Americans to pay for other people's abortions and to coerce medical professional to take the lives of unborn children.”
Senator Tom Coburn, R, Oklahoma, December 24, 2009
“The United States stands on the verge of the most significant change to our health care system since the 1965 introduction of Medicare. The bill that was passed by the House and a parallel bill before the Senate would cover most uninsured Americans, saving thousands of lives each year and putting an end to our status as the only developed country that places so many of its citizens at risk for medical bankruptcy. Moreover, the bills would accomplish this aim while reducing the federal deficit over the next decade and beyond. They would reform insurance markets, lower administrative costs, increase people’s insurance choices, and provide “insurance for the insured” by disallowing medical underwriting and the exclusion of preexisting conditions. And the Senate bill in particular would move us closer to taming the uncontrolled increase in health care spending that threatens to bankrupt our society.”
“The current bills are not perfect. The Senate Bill has a mandate that’s too weak and doesn’t provide enough insurance to low-income individuals, and the House bill doesn’t do enough to control costs. Nevertheless, passage of a hybrid bill would be a major accomplishment and a turning point for our dysfunctional health care system. We should constructively support Congress’s efforts to create a combined bill, rather than leveling unsubstantiated criticisms from the sidelines.
Jonathon Gruber, PhD, “Getting The Facts Straight on Health Care Reform,” New England Journal of Medicine, December 24, 2009
“This vote is indeed historic. This Congress will be remembered for its arrogance, corruption and stupidity. In the year of 2009, a Congress ignored the coming economic storm and impending bankruptcy of our entitlement programs and embarked on an ideological crusade to bring our nation as close to single-payer, government-run health care as possible. If this bill becomes law, future generations will rue this day and I will do everything in my power to work toward its repeal. This bill will ration care, cut Medicare, increase premiums, fund abortion and bury our children in debt.”
“This process was not compromise. This process was corruption. This bill passed because votes were bought and sold using the issue of abortion as a bargaining chip. The abortion provision alone makes this bill the most arrogant piece of legislation I have seen in Congress. Only the most condescending politician can believe it is appropriate to force Americans to pay for other people's abortions and to coerce medical professional to take the lives of unborn children.”
Senator Tom Coburn, R, Oklahoma, December 24, 2009
“The United States stands on the verge of the most significant change to our health care system since the 1965 introduction of Medicare. The bill that was passed by the House and a parallel bill before the Senate would cover most uninsured Americans, saving thousands of lives each year and putting an end to our status as the only developed country that places so many of its citizens at risk for medical bankruptcy. Moreover, the bills would accomplish this aim while reducing the federal deficit over the next decade and beyond. They would reform insurance markets, lower administrative costs, increase people’s insurance choices, and provide “insurance for the insured” by disallowing medical underwriting and the exclusion of preexisting conditions. And the Senate bill in particular would move us closer to taming the uncontrolled increase in health care spending that threatens to bankrupt our society.”
“The current bills are not perfect. The Senate Bill has a mandate that’s too weak and doesn’t provide enough insurance to low-income individuals, and the House bill doesn’t do enough to control costs. Nevertheless, passage of a hybrid bill would be a major accomplishment and a turning point for our dysfunctional health care system. We should constructively support Congress’s efforts to create a combined bill, rather than leveling unsubstantiated criticisms from the sidelines.
Jonathon Gruber, PhD, “Getting The Facts Straight on Health Care Reform,” New England Journal of Medicine, December 24, 2009
Notes of An Ideological Pragmatist
I’m an ideological pragmatist. I believe in what works and what suits the temperament of American people, rather than what is politically correct or what passes some moral litmus test.
Public-Private Mix
Whatever reform measure passes, It will be a public-private mix, it will superimpose more government regulations on our private system. It will have uneven effects. It will cost more than the status quo. And it will expose the reality, that when it comes to health reform, Democrats and Republicans have their ideological blinders on.
All developed nations have a mix of public and private systems. The United Kingdom has the NHS (National Health Service) and BUPA (British United Provident Association and other private plans); Canada has its Medicare and private insurance plans to help citizens escape waiting lines .
It comes donw to questions of the socialist-capitalist mix, how much goverment consumes of a nation's GDP, what citizens are willing to cough up in taxes, what choices they are willing to give up, how long they are willing to wait for life-saving and function-restoring technologies, how free they want to be in their personal decision making , and how economically secure they want to be in health care matters.
Everybody in all countries knows if you have money and connections, you can jump the public queue to get care. In the U.S. Medicare and Medicaid cover about 105 million of our 310 million citizens at a cost of about $1 trillion, while private plans care for the rest for roughly $1.5 trillion. Then, of course, there are those “cadillac plans,” which offer rich benefits, mostly of members of powerful unions.
Health Reform as an “Ideological Exercise”
Democrats harbor the illusion of a high moral duty to care for all by expanding federal regulations to care for all. It may be more about political power than moral obligation. Nolan Finley, reporting in today’s Detroit News, says the “most tangible fallout of the electorate single-powerful rule in Washington is that public policy making has become an ideological exercise, rather than a pragmatic one.” Translated, this means, by God we Demoorats have unlimited power, and we’re going to exercise it, no matter what the consequences.
Meanwhile Republicans seem to think Democratic power leads to serfdom, and the only solution is freeing the market from federal regulations, letting entrepreneurs innovate , and having consumers pay their money and make their choices. This isn't going to happen, given embedded liberal ideologies of equity and equal outcomes and current political power.
Connections and Ideology
One’s connections shape one’s ideology. I am no exception. I work closely with The Physicians’ Foundation, a nonprofit organization representing some 650,000 practicing physicians in state and local medical societies, and for the last 10 years, I have been on the MedicaL Advisory Board of Castle Connolly’s Top Doctors, which is closely linked to the nation’s top academic medical centers.
From the Foundation, I’ve learned most physicians cherish independence and direct relationships with patients without 3rd party interference. These physicians, contrary to what you might hear about AMA support of current health reform, tend to be profoundly skeptical of House-Senate bills because of their intrusiveness into doctor-patient relationships and constant lowering of reimbursements.
From the Top Doctor organization, made up mostly of more 3000 physicians practicing in America’s 125 academic hospitals, I’ve learned academics are skeptical as well. They are especially leery of the proposed $500 billion Medicare cuts proposed over the next ten years. High tech care of Medicare patients is often the life-blood of these institutions.
The American People
From recent public polls, I’ve learned 60 percent to 70 percent of the public do not believe reform will lower costs or improve care, or change their overall care for the better. At this stage, because of unemployment of over 10 percent, the perceived ineffectiveness of the massive stimulus bill, and soaring federal deficits, public belief in government intervention is at an all time low.
Because of these various factors, I remain pragmatic and skeptical about the ultimate outcome of reform and its political and practical consequences. To me talk of successful reform as “historic” remains mostly political histrionics. Time will tell how reform shakes out and whether criticism from the sidelines is factual or simply political jealousy. We do not yet know the impact or implications of this partisan party line bill, or how its final version will evolve.
Public-Private Mix
Whatever reform measure passes, It will be a public-private mix, it will superimpose more government regulations on our private system. It will have uneven effects. It will cost more than the status quo. And it will expose the reality, that when it comes to health reform, Democrats and Republicans have their ideological blinders on.
All developed nations have a mix of public and private systems. The United Kingdom has the NHS (National Health Service) and BUPA (British United Provident Association and other private plans); Canada has its Medicare and private insurance plans to help citizens escape waiting lines .
It comes donw to questions of the socialist-capitalist mix, how much goverment consumes of a nation's GDP, what citizens are willing to cough up in taxes, what choices they are willing to give up, how long they are willing to wait for life-saving and function-restoring technologies, how free they want to be in their personal decision making , and how economically secure they want to be in health care matters.
Everybody in all countries knows if you have money and connections, you can jump the public queue to get care. In the U.S. Medicare and Medicaid cover about 105 million of our 310 million citizens at a cost of about $1 trillion, while private plans care for the rest for roughly $1.5 trillion. Then, of course, there are those “cadillac plans,” which offer rich benefits, mostly of members of powerful unions.
Health Reform as an “Ideological Exercise”
Democrats harbor the illusion of a high moral duty to care for all by expanding federal regulations to care for all. It may be more about political power than moral obligation. Nolan Finley, reporting in today’s Detroit News, says the “most tangible fallout of the electorate single-powerful rule in Washington is that public policy making has become an ideological exercise, rather than a pragmatic one.” Translated, this means, by God we Demoorats have unlimited power, and we’re going to exercise it, no matter what the consequences.
Meanwhile Republicans seem to think Democratic power leads to serfdom, and the only solution is freeing the market from federal regulations, letting entrepreneurs innovate , and having consumers pay their money and make their choices. This isn't going to happen, given embedded liberal ideologies of equity and equal outcomes and current political power.
Connections and Ideology
One’s connections shape one’s ideology. I am no exception. I work closely with The Physicians’ Foundation, a nonprofit organization representing some 650,000 practicing physicians in state and local medical societies, and for the last 10 years, I have been on the MedicaL Advisory Board of Castle Connolly’s Top Doctors, which is closely linked to the nation’s top academic medical centers.
From the Foundation, I’ve learned most physicians cherish independence and direct relationships with patients without 3rd party interference. These physicians, contrary to what you might hear about AMA support of current health reform, tend to be profoundly skeptical of House-Senate bills because of their intrusiveness into doctor-patient relationships and constant lowering of reimbursements.
From the Top Doctor organization, made up mostly of more 3000 physicians practicing in America’s 125 academic hospitals, I’ve learned academics are skeptical as well. They are especially leery of the proposed $500 billion Medicare cuts proposed over the next ten years. High tech care of Medicare patients is often the life-blood of these institutions.
The American People
From recent public polls, I’ve learned 60 percent to 70 percent of the public do not believe reform will lower costs or improve care, or change their overall care for the better. At this stage, because of unemployment of over 10 percent, the perceived ineffectiveness of the massive stimulus bill, and soaring federal deficits, public belief in government intervention is at an all time low.
Because of these various factors, I remain pragmatic and skeptical about the ultimate outcome of reform and its political and practical consequences. To me talk of successful reform as “historic” remains mostly political histrionics. Time will tell how reform shakes out and whether criticism from the sidelines is factual or simply political jealousy. We do not yet know the impact or implications of this partisan party line bill, or how its final version will evolve.
Saturday, December 26, 2009
Health Reform By The Numbers
I’m a numbers person. You can talk all you want about effects of health reform. But I won’t be impressed until I see the numbers, provided, of course, the numbers fit my point of view. When politicians start throwing around numbers, it's generally about budgets, and how to fix them to match them to fit your view of the world.
Democrats say they are going to sell their reform bill by talking about those 31million that will now be covered and those 5 million, or whatever the real number is, that will no longer be denied coverage for pre-existing conditions or expensive dieases. This is an important selling point since 133 million Americans are estimated to have chronic disease.
Republicans will seek to discredit health reform bills by saying the bills will cost $2.3 trillion, not $879 billion, taxes will start in 2010 but benefits don’t kick in until 2015, true costs will explode after 2019, and bureaucrats not doctors will be practicing medicine.
The true numbers, as we know them now, before the reconciliation (that’s the term being used to describe the divorce settlement between liberal and conservation Democrats). It's worth taking a numeric stab about what how the numbers might shake out.
According to the Congressional Budget Office, the budget numbers for the years 2010 to 2019, are,
• $395 billion in federal spending to expand the number of people covered by Medicaid and CHIP, insurance programs for the poor. Comment: The feds say these numbers are modest considering benefits to the uninsured ; the states say the numbers are crushing and unsustainable.
• $436 billion in federal spending to pay for health-insurance exchanges that be used by people who don’t get health insurance through work. Most of that money will come as subsidies for insurance premiums for people earning up to four times the poverty level. Comment: Cynics say some families making $96,000 would qualify, depending on how you parse the numbers.
• $398 billion in new taxes. That includes the tax on high-value health-insurance plans, new fees on health insurers and drug and device makers, higher payroll taxes for high earners, and indirect taxes on consumers and the middle class as you pass effects of new high taxes onto new premium costs. Comment: Do the effects of these higher taxes and higher costs leave anyone out?
• $483 billion in cuts to projected spending for Medicare and other programs. This includes reductions in projected costs for privately administered Medicare Advantage programs and a new formula likely to lower annual increases in payments to hospitals. Comment: These are numbers likely never to materialize if the history of Medicare is any guide.
• 31 million additional people would have health insurance by 2019 because of the bill and 23 million people in this country would still be uninsured. Comment: Don’t worry about the 23 million. We’ll cover them later.
So there you have it – a rundown on the numbers. I trust I have helped you understand the effect of health reform through this numbers exercise. Health reform is not rocket science. It is numerical. It is not numerological – a system of occultism based on how many people might abuse, overuse, or be confused by what lies ahead. Health reform is based on hard numbers, subject to two by ifs - human responses to budget incentives and shifts in the political landscape.
Democrats say they are going to sell their reform bill by talking about those 31million that will now be covered and those 5 million, or whatever the real number is, that will no longer be denied coverage for pre-existing conditions or expensive dieases. This is an important selling point since 133 million Americans are estimated to have chronic disease.
Republicans will seek to discredit health reform bills by saying the bills will cost $2.3 trillion, not $879 billion, taxes will start in 2010 but benefits don’t kick in until 2015, true costs will explode after 2019, and bureaucrats not doctors will be practicing medicine.
The true numbers, as we know them now, before the reconciliation (that’s the term being used to describe the divorce settlement between liberal and conservation Democrats). It's worth taking a numeric stab about what how the numbers might shake out.
According to the Congressional Budget Office, the budget numbers for the years 2010 to 2019, are,
• $395 billion in federal spending to expand the number of people covered by Medicaid and CHIP, insurance programs for the poor. Comment: The feds say these numbers are modest considering benefits to the uninsured ; the states say the numbers are crushing and unsustainable.
• $436 billion in federal spending to pay for health-insurance exchanges that be used by people who don’t get health insurance through work. Most of that money will come as subsidies for insurance premiums for people earning up to four times the poverty level. Comment: Cynics say some families making $96,000 would qualify, depending on how you parse the numbers.
• $398 billion in new taxes. That includes the tax on high-value health-insurance plans, new fees on health insurers and drug and device makers, higher payroll taxes for high earners, and indirect taxes on consumers and the middle class as you pass effects of new high taxes onto new premium costs. Comment: Do the effects of these higher taxes and higher costs leave anyone out?
• $483 billion in cuts to projected spending for Medicare and other programs. This includes reductions in projected costs for privately administered Medicare Advantage programs and a new formula likely to lower annual increases in payments to hospitals. Comment: These are numbers likely never to materialize if the history of Medicare is any guide.
• 31 million additional people would have health insurance by 2019 because of the bill and 23 million people in this country would still be uninsured. Comment: Don’t worry about the 23 million. We’ll cover them later.
So there you have it – a rundown on the numbers. I trust I have helped you understand the effect of health reform through this numbers exercise. Health reform is not rocket science. It is numerical. It is not numerological – a system of occultism based on how many people might abuse, overuse, or be confused by what lies ahead. Health reform is based on hard numbers, subject to two by ifs - human responses to budget incentives and shifts in the political landscape.
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